SECTION 5 - OBSTETRIC EMERGENCIES

5/6.5.1 Pre-Hospital Emergency Childbirth

05/08
P AP

Query labour

Take SAMPLE history

If no progress with
labour consider Patient in
No
transporting patient labour

Yes

Birth imminent or
No
travel time too long

Yes

Request Ambulance Control to contact GP /

Pre-Hospital Emergency Childbirth

Request Equipment list

midwife/ medical team as required by local policy
to come to scene or meet en route ALS Cord Clamps
Bulb syringe
Towels
Surgical gloves
Surgical apron
Consider Position mother and prepare Gauze swaps 10 x 10 cm
equipment for birth Umbilical cord scissors
Entonox Clinical waste bag
Neonatal BVM
Monitor vital signs and BP
OBSTETRIC EMERGENCIES

Go to Cord
Cord
Complication Yes
complication
CPG

No

Go to
Breech
Breech Birth Yes
birth
CPG
No

Support baby
throughout delivery

S5 Dry baby and

check ABCs

Go to
Neonate Baby
No
Resuscitation stable
CPG
Yes

Clamp & cut cord Clamp cord at 10, 15

& 20 cm from baby
Cut cord between 15
Wrap baby and
and 20 cm clamps
present to mother

Go to
Primary Mother
No
Survey stable
CPG
Yes

If placenta delivers, bring to

Reassess
hospital with mother

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5/6.5.2
05/08 Basic & Advanced Life Support – Neonate (< 4 weeks) P AP

From
Childbirth Birth
CPG

Term gestation
Amniotic fluid clear Yes

Basic & Advanced Life Support - Neonate (< 4 weeks)

Breathing or crying
< 4 weeks old Good muscle tone

No

Request

ALS
Initiate mobilisation of 3 to 4
practitioners / responders
on site to assist with cardiac Provide warmth Provide warmth
arrest management Position; Clear airway if necessary Dry baby
Dry, stimulate, reposition

Assess respirations,
heart rate & colour Breathing, HR > 100
Apnoeic or HR < 100

OBSTETRIC EMERGENCIES
Breathing, HR > 100 but Cyanotic

Give Supplementary O2

Persistent
CPR 3 : 1 No
Cyanosis
Compressions : Ventilations

Yes

Provide positive pressure ventilation for 30 sec

HR < 60
Assess Heart
Rate
HR 60 to 100 S5
CPR (ratio 3:1) for 30 sec
Breathing well, HR > 100

Assess Heart
HR 60 to 100 Breathing well, HR > 100
Rate

HR < 60

Continue CPR

Consider blood Epinephrine (1:10 000) 0.01 mg/kg IV/ IO

glucose check Every 3 to 5 minutes prn

If mother is opiate user consider

Naloxone, 0.01 mg/kg IV/IO
Or
Naloxone, 0.01 mg/kg IM

Consider
NaCl 0.9%, 10 mL/kg IV/IO

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5/6.5.3
05/08 Haemorrhage in Pregnancy Prior to Delivery P AP

Query pregnant Pregnancy

< 24 weeks ! 24 weeks
Early pregnancy Anti partum
haemorrhage haemorrhage

Left lateral tilt

Haemorrhage in Pregnancy Prior to Delivery

Do not examine
abdomen or vagina

Apply absorbent pad to perineum

area

Oxygen therapy

Patient is
Yes haemodynamically No
unstable
OBSTETRIC EMERGENCIES

Request

ALS

Reassess

Go to
Shock
CPG

S5

Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12th Edition, Bailleire Tindall

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5/6.5.4 Postpartum Haemorrhage

05/08 P AP

2nd stage of
labour complete

Apply absorbent pad to perineum

area

Estimate
blood loss
Oxygen therapy

Syntometrine, 1 mL IM
(if not already administered)

Mother is
Yes haemodynamically No
unstable

Request

ALS

Postpartum Haemorrhage
External massage of the uterus

Check/ ask mother re

Reassess
multiple births prior to Elevate lower limbs

OBSTETRIC EMERGENCIES
administration of
Syntometrine

AP Consider
inserting a urinary
catheter

Go to
Shock
CPG

S5

Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12th Edition, Bailleire Tindall

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5/6.5.5 Umbilical Cord Complications

05/08 P AP

Cord
complication

Request Request Ambulance Control to contact GP /

midwife/ medical team as required by local policy
ALS to come to scene or meet en route

Oxygen therapy

Cord around
baby’s neck Cord rupture Prolapsed cord

Apply additional
Attempt to slip the cord Mother to adopt
clamps to cord
over the baby’s head knee chest position

Apply direct pressure

with sterile dressing AP Hold presenting part off
Yes Successful
the cord using fingers
Umbilical Cord Complications

No
Maintain cord temperature
Clamp cord in two places and and moisture
cut between both clamps

Ease the cord from AP Consider inserting an indwelling catheter

into the bladder and run 500 mL of NaCl
OBSTETRIC EMERGENCIES

around the neck into the bladder and clamp catheter

Go to
Childbirth In labour No
CPG

Yes

Consider
Nifedipine, 20 mg, PO

S5

For prolapsed cord pre-alert

hospital as emergency caesarean
section will be required

Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12th Edition, Bailleire Tindall
Katz Z et al, 1988, Management of labor with umbilical cord prolaps: A 5 year study. Obstet. Gynecol. 72(2): 278-281
Duley, LMM, 2002, Clinical Guideline No 1(B), Tocolytic Drugs for women in preterm labour, Royal College of Obstetricians and gynaecologists

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5/6.5.6
05/08 Breech Birth P AP

Breech birth
presentation

Request Request Ambulance Control to contact GP /

midwife/ medical team as required by local policy
ALS to come to scene or meet en route

Oxygen therapy

Mother to adapt the lithotomy position

Support the baby as it emerges –

avoid manipulation of the baby’s body

Yes Successful
No
delivery

No

OBSTETRIC EMERGENCIES
Nape of neck
anteriorly visible at No
vulva

Breech Birth
Go to
Consider Childbirth Yes
CPG
Entonox

Place one hand, palm up, onto

baby’s face

Grasp both baby’s ankles in other

hand

Rotate baby’s legs in an arc

S5
in an upward direction as
contractions occur

Successful
Yes delivery after 5
contractions

No

Place hand in the vagina with palm towards baby’s face

Form a V with fingers on each side of baby’s nose and
gently push baby’s head away from vaginal wall

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